Impact of case-relevant and case-irrelevant communication within the surgical team on surgical-site infection.

BACKGROUND: Surgical-site infections (SSIs) are the most common complications after surgery. An influence from talking and distractions during surgery on patient outcomes has been suggested, but there is limited evidence. The aim of this prospective observational study was to assess the relationship between intraoperative communication within the surgical team and SSI, and between intraoperative distractions and SSI. METHODS: This prospective observational study included patients undergoing elective, open abdominal procedures. For each procedure, intraoperative case-relevant and case-irrelevant communication, and intraoperative distractions were observed continuously on site. The influence of communication and distractions on SSI after surgery was assessed using logistic regressions, adjusting for risk factors. RESULTS: A total of 167 observed procedures were analysed; their mean(s.d.) duration was 4·6(2·1) h. A total of 24 SSIs (14·4 per cent) were diagnosed. Case-relevant communication during the procedure was independently associated with a reduced incidence of organ/space SSI (propensity score-adjusted odds ratio 0·86, 95 per cent c.i. 0·77 to 0·97; P = 0·014). Case-irrelevant communication during the closing phase of the procedure was independently associated with increased incidence of incisional SSI (propensity score-adjusted odds ratio 1·29, 1·08 to 1·55; P = 0·006). Distractions had no association with SSI. CONCLUSION: More case-relevant communication was associated with fewer organ/space SSIs, and more case-irrelevant communication during wound closure was associated with incisional SSI.

Impact of team familiarity in the operating room on surgical complications.

BACKGROUND: The quality of surgical performance depends on the technical skills of the surgical team as well as on non-technical skills, including teamwork. The present study evaluated the impact of familiarity among members of the surgical team on morbidity in patients undergoing elective open abdominal surgery. METHODS: A retrospective analysis was performed to compare the surgical outcomes of patients who underwent major abdominal operations between the first month (period I) and the last month (period II) of a 6-month period of continuous teamwork (stable dyads of one senior and one junior surgeon formed every 6 months). Of 117 patients, 59 and 58 patients underwent operations during period I and period II, respectively, between January 2010 and June 2012. Team performance was assessed via questionnaire by specialized work psychologists; in addition, intraoperative sound levels were measured. RESULTS: The incidence of overall complications was significantly higher in period I than in period II (54.2 vs. 34.5 %; P = 0.041). Postoperative complications grade <3 were significantly more frequently diagnosed in patients who had operations during period I (39.0 vs. 15.5 %; P = 0.007), whereas no between-group differences in grade ≥3 complications were found (15.3 vs. 19.0 %; P = 0.807). Concentration scores from senior surgeons were significantly higher in period II than in period I (P = 0.033). Sound levels during the middle third part of the operations were significantly higher in period I (median above the baseline 8.85 dB [range 4.5-11.3 dB] vs. 7.17 dB [5.24-9.43 dB]; P < 0.001). CONCLUSIONS: Team familiarity improves team performance and reduces morbidity in patients undergoing abdominal surgery.

Comparison of pain-resilient working individuals to population-based case controls with/without momentary low back pain.

BACKGROUND: Few studies have examined the 20% of individuals who never experience an episode of low back pain (LBP). To date, no investigation has been undertaken that examines a group who claim to have never experienced LBP in their lifetime in comparison to two population-based case-control groups with and without momentary LBP. This study investigates whether LBP-resilient workers between 50 and 65 years had better general health, demonstrated more positive health behaviour and were better able to achieve routine activities compared with both case-control groups. METHODS: Forty-two LBP-resilient participants completed the same pain assessment questionnaire as a population-based LBP sample from a nationwide, large-scale cross-sectional survey in Switzerland. The LBP-resilient participants were pairwise compared to the propensity score-matched case controls by exploring differences in demographic and work characteristics, and by calculating odds ratios (ORs) and effect sizes. A discriminant analysis explored group differences, while the multiple logistic regression analysis specified single indicators which accounted for group differences. RESULTS: LBP-resilient participants were healthier than the case controls with momentary LBP and achieved routine activities more easily. Compared to controls without momentary LBP, LBP-resilient participants had a higher vitality, a lower workload, a healthier attitude towards health and behaved more healthily by drinking less alcohol. CONCLUSIONS: By demonstrating a difference between LBP-resilient participants and controls without momentary LBP, the question that arises is what additional knowledge can be attained. Three underlying traits seem to be relevant about LBP-resilient participants: personality, favourable work conditions and subjective attitudes/attributions towards health. These rationales have to be considered with respect to LBP prevention.

Human factors in resuscitation: Lessons learned from simulator studies.

Medical algorithms, technical skills, and repeated training are the classical cornerstones for successful cardiopulmonary resuscitation (CPR). Increasing evidence suggests that human factors, including team interaction, communication, and leadership, also influence the performance of CPR. Guidelines, however, do not yet include these human factors, partly because of the difficulties of their measurement in real-life cardiac arrest. Recently, clinical studies of cardiac arrest scenarios with high-fidelity video-assisted simulations have provided opportunities to better delineate the influence of human factors on resuscitation team performance. This review focuses on evidence from simulator studies that focus on human factors and their influence on the performance of resuscitation teams. Similar to studies in real patients, simulated cardiac arrest scenarios revealed many unnecessary interruptions of CPR as well as significant delays in defibrillation. These studies also showed that human factors play a major role in these shortcomings and that the medical performance depends on the quality of leadership and team-structuring. Moreover, simulated video-taped medical emergencies revealed that a substantial part of information transfer during communication is erroneous. Understanding the impact of human factors on the performance of a complex medical intervention like resuscitation requires detailed, second-by-second, analysis of factors involving the patient, resuscitative equipment such as the defibrillator, and all team members. Thus, high-fidelity simulator studies provide an important research method in this challenging field.

Predictors of multidimensional outcome after spinal surgery.

The variables identified as predictors of surgical outcome often differ depending on the specific outcome variable chosen to designate "success". A short set of multidimensional core outcome measures was recently developed, in which each of the following domains was addressed with a single question and then combined in an index: pain, function, symptom-specific well-being, general well-being (quality of life), disability (work and social). The present study examined the factors that predicted surgical outcome as measured using the multidimensional core measures. 163 spinal surgery patients (mixed indications) completed questionnaires before and 6 months after surgery enquiring about demographics, medical/clinical history, fear-avoidance beliefs (FABQ), depression (Zung self-rated depression), and the core measures domains. Multiple regression analyses were used to identify predictor variables for each core domain and for the multidimensional combined core-set index. The combination of baseline symptoms, medical variables (pain duration, previous spine operations, number of levels treated, operative procedure) and psychosocial factors (FABQ and Zung depression) explained 34% of the variance in the core measures index (P < 0.001). With regard to the individual domain items, the medical variables were better in predicting the items "pain" and "symptom-specific well-being" (R (2) = 6-7%) than in predicting "function", "general well-being" or "disability" (each R (2) < 4%). The inverse pattern was shown for the psychosocial predictors, which accounted for in each case approximately 20% variance in "function", "general well-being" and "disability" but only 12-14% variance in "pain" and "symptom-specific well-being". Further to previous studies establishing the sensitivity to change of the core-set, we have shown that a large proportion of the variance in its scores after surgery could be predicted by "well-known" medical and psychosocial predictor variables. This substantiates the recommendation for its further use in registry systems, quality management projects, and clinical trials.

Work stress and patient safety: observer-rated work stressors as predictors of characteristics of safety-related events reported by young nurses.

This study investigates the link between workplace stress and the 'non-singularity' of patient safety-related incidents in the hospital setting. Over a period of 2 working weeks 23 young nurses from 19 hospitals in Switzerland documented 314 daily stressful events using a self-observation method (pocket diaries); 62 events were related to patient safety. Familiarity of safety-related events and probability of recurrence, as indicators of non-singularity, were the dependent variables in multilevel regression analyses. Predictor variables were both situational (self-reported situational control, safety compliance) and chronic variables (job stressors such as time pressure, or concentration demands and job control). Chronic work characteristics were rated by trained observers. The most frequent safety-related stressful events included incomplete or incorrect documentation (40.3%), medication errors (near misses 21%), delays in delivery of patient care (9.7%), and violent patients (9.7%). Familiarity of events and probability of recurrence were significantly predicted by chronic job stressors and low job control in multilevel regression analyses. Job stressors and low job control were shown to be risk factors for patient safety. The results suggest that job redesign to enhance job control and decrease job stressors may be an important intervention to increase patient safety.

Patterns of physical activity among German adolescents: the Berlin-Bremen Study.

Patterns of leisure-time physical activity among 932 West German boys and girls from two distinct socioeconomic groups were examined longitudinally over a 2-year period beginning with seventh to eighth grade students. Activity indices reflect the weekly time spent in activities, the weekly frequency of participation, and the average duration per activity episode. The indices refer to all activities, to moderate or vigorous activities, or to each individual activity. The average seventh to eighth grade student spent 10.1 hr/week engaged in all of the activities measured. Overall, the time devoted to these activities declined by 10% during the 2-year study period, with the relative decrease being larger for vigorous than for moderate activities. The decline in time spent in vigorous activity was due to a decreased frequency of participation; whereas the decline in moderate activity was primarily attributable to the decreased average duration per episode. Boys spent about 3 hr/week more in all activities than girls, with the difference largely being due to the boys' greater participation in vigorous activities. Weekly activity time among girls did not vary substantially with socioeconomic status. However, compared with boys of higher socioeconomic status, boys in the lower socioeconomic grouping were 2-3 hr/wk more active because they devoted more time to moderate activities. The results indicate that the identified activity patterns in the population strongly depend on the activity dimensions on which the measure focuses.

Low-level cigarette smoking and longitudinal change in serum cholesterol among adolescents. The Berlin-Bremen Study.

The current study was conducted to determine if smokers and nonsmokers differ in serum concentrations of high-density lipoprotein cholesterol (HDL-C) before smoking initiation and if a decline in HDL-C levels could be detected among adolescents during the first two years of smoking. Changes in HDL-C levels and smoking were observed longitudinally in 1983, 1984, and 1985 among 691 seventh and eighth graders (age range, 12 to 14 years) from two German cities; 82% were nonsmokers at baseline. For these baseline nonsmokers, no differences in baseline HDL-C concentrations were found between those who became smokers and those who remained nonsmokers. In contrast, those who became light (one to 39 cigarettes per week) or moderate (greater than or equal to 40 cigarettes per week) smokers by one or two years after the initial examination evidenced lower mean HDL-C concentrations relative to persistent nonsmokers at follow-up, constituting a decrement of -0.016 mmol/L [SE = .035] (-0.6 mg/dL) [SE = 1.4] for light smokers and -0.114 mmol/L [SE = .064] (-4.4 mg/dL) [SE = 2.5] for moderate smokers. These findings suggest that short-term exposure to cigarette smoke at low levels may have atherogenic consequences.